Searching for the Essential Simplicity that underlies all complex subjects. Of my 168 posts (listed in 'Blog Archive') the currently most popular are automatically listed in the right hand column. Total Reads (To date: 46,819 hits)

Thursday, 24 March 2016

There seem to be three issues: gut feeling, distrust, and economics. The out-campaign emphasises gut feeling and distrust, the in-campaign emphasises economics.

I think we all start with a gut feeling. Are you European or British? Some in Britain feel European, thrilled to belong to the culture of Grieg, Rembrandt, Bach, Montaigne, Dante, Cervantes, Socrates. Others have more local loyalties; e.g. England, London, Chelsea.

Perhaps the next strongest decider is distrust of strangers. Do we trust the civil servants, politicians, and judges of other member countries to make sensible, humane, and fair judgements? Or is common sense a British monopoly? Looking at labour relations, education, transport, etc. it is clear that we should trust the 6 founder western European democracies, and in fact we have much to learn. They (with Britain) account for 60% of the people of the EU (and 72% of the GDP). We still do not know much about the poorer countries on the eastern and southern fringes of Europe, and some degree of caution is perfectly rational. (Incidentally, though we are the 2nd largest economy in the EU, we are only the 11th wealthiest nationper caput. We have plenty to be humble about.)

However, most of the discussion is about the financial benefits of membership. Here, I would like to make one point that I have not yet seen advanced by other commentators. I think a nation even of our size is still too small to stand up to large commercial and financial concerns. Our annual gross domestic product is around 2.9 trillion £; the annual cost of the entire NHS is 0.096T£. But the total assets of Barclays Bank are 1.36 trillion £ (T£), that of HSBC 1.84. How can we ‘control’ these banks when they have a common interest and ‘gang up’? Is this not why all the capitalist economies are getting ever deeper into debt? For debt is the income stream of the money lender. Nor is it just the banks. Royal Dutch Shell has total assets of 0.35 T£. Walmart has a net annual income of 0.33 T£. I think there is a great danger when a country can be held to ransom by powerful independent interests with objectives that differ from the National Interest.

It is clear that welding a united Europe is difficult, and may take time. But some level of unity must be achieved. We just have to try harder, with more skill and flexibility. The European Union has required gigantic effort to get even this far. I am for going forward, rather than going back.

The art and the Science of Child Psychiatry

At first glance I was
puzzled by the title of this book. Perhaps West was challenged by management to
say what exactly he did when closeted with his young patients session after
session, over a period often extending to months. And West may have eased his
annoyance with a deprecatory verbal shrug along the lines of“Just being there with them!”.I was further puzzled by Chapter 1. It
seemed the first page of the book was missing. We learn about ‘potential
space’, the difference between ‘being’ and ‘being with’, between ‘having’ and
‘doing’, the importance of ‘being oneself’, of ‘silence’. But what is this book
about? At whom it is directed? What does the author mean by “being with”? The writing is lucid, easy
and precise, and the points are subtle; how can he have overlooked these elementary
questions? Gradually it dawns on us that West is illustrating his own method;
we (the readers) are ourselves constructing the meaning from the ideas strewn
in our way. [“..the new…therapeutic ideas…have to be discovered, rather than
pushed into the conversation.” p. 55]

There follow two
chapters (“The Intrusion of Reality”, “The Nature of Evidence”) in which a
torrent of anger is directed against Health Service Managers, commissioners, politicians,
and ‘modern life’ in general. Here West inveighs with passion, but his targets
are valid and his points well argued. Does the system overvalue numbers? What
does ‘in a timely fashion’ mean? Is it better to be ‘timely’ than ‘effective’? Does
‘evidenced-based medicine’ necessarily exclude psychiatry, and the placebo? (In
which case, is it excluding too much?) Attention is drawn to the harm of premature
diagnosis, of overprescribing, to the value of inaction, to the dehumanising
and demotivating effect of uncaring non-clinical managers.Are we forgetting the value of ”reason,
experience, analogy, instinct, and memory?” [p. 53]. West may seem to be doing
little more than lamenting, but I ended these chapters feeling that something
precious is in danger of being lost, something valuable to the practice of
medicine, even something essential to humanity.

A book, West points
out, needs two covers; the front cover to attract, the back cover to close, to
say “good bye” [p. 156]. In the central chapters we are taken carefully through
the entire therapeutic process from the first eye-contact between clinician and
patient on their way from waiting room to consulting room, to the solemn “Good
bye” that ends the treatment. But this book makes no attempt to be a text-book
of clinical practice and the nitty-gritty detail is entirely eschewed. What is
examined is the less-easily-seen, the ‘between-the-lines’ stuff, the
hard-to-describe stuff. It is this core that makes the book, with its subtle
observations and its carefully nuanced writing, valuable and rare (it not
unique).

There is, in general,
a lightness in the text, and a sense of humour that makes the book enjoyable
reading. There are one or two obscurities, and one or two laboured passages. (West,
arguing both for and against diagnosis, cannot decide which is going to have
the last word.) But there are many lovely points. (The bus driver who turns to
his passenger and says “You should never presume a thing”; to illustrate the
point that the clinician should not ‘presume’ his duty is to remove the 'presenting
symptom’; it may be there because the patient ‘needs’ it. And is it true that
the NHS manual of diagnostic codes does not have a code for ‘normal’?
Fabulous!) West clearly
enjoys making his readers think. We must distinguish (it seems) between
evidence and “evidence”…. “It is a confident uncertainty that needs to be
projected at this stage.” And thinking (we are told) does not occur only in
heads, but also “in the space between heads”.

This is a creative,
inspiring, even an uplifting, book. With luck, the complacent reader will come away
from it more aware of his shortcomings and frailties, but at the same time with
a vision of perceptiveness and humanity .

Tuesday, 8 March 2016

PER DiEM: Can one
Save Europe by appealing to Democracy?

The trouble is (and
you know this as well as anyone) that a democracy is a rickety boat with a host
of opinionated pilots, dozens of helmsmen, and a barely effective rudder. Here,
in Britain, we should have as good a chance of it working as anywhere, but it
does not work here; the pilots give up and the helmsmen squabble among
themselves for a hand on the tiller. We are dazzled and exhausted by the
barrage of conflicting views presented by the media. We (in Britain) find that
most of our votes are not actually represented in the House of Commons, and so are
pointless.

Our forthcoming
referendum is of course different; for every vote will count.But it is even more difficult for the
average voter to assess the arguments. There is enormous ignorance in the
country about the workings of the European Union, and the mechanisms of power.

It is widely held that
democracy, while a poor thing, is the best form of government available. We all
pay lip-service to DEMOCRACY. But do we truly believe in it? The counterpart of ‘oi demoi’ is ‘oi aristoi’ ; the opposite of democracy
is aristocracy. There is a widespread view among the average working person that
these difficult matters are best left to the clever few. And that view is, alas,
both sensible and largely correct.

The ‘demos’, though sound on morality, is
relatively ignorant of the details of government. This ignorance is
inescapable, for there are very few people that can acquire more than a
fraction of the information, and hold it long enough to form and assess
arguments. Even these few must blindly trust their sources. It is not for
wisdom that we turn to the ‘demos’.Morality, on the other hand, belongs to
the ‘demos’; it can scarcely be said
to exist except in the ‘demos’ . Individuals may be high-minded
or base, altruistic or selfish; it is only when you average out all the
variation that you can conclude what is “right action”.

Unfortunately,
ignorance often trumps morality; the ‘demos’
can be played upon by anyone with adequate rhetorical skills. Hitler marched a
nation to war, while our own finance ministers can trick us into cutting taxes,
and benefits. (“The worker voting for a tax-cut is like a mouse voting for a
mouse-trap, thinking of the cheese.”)We can hardly rely on the moral compass of the voting public, except in
the long term. It might take a decade. It might take a generation.

So, does one have to
join the ranks of those trying to manipulate the public?You travel, and speak. You blog and post videos. You hope that you inspire some. But your message must be essentially simple,
clearly honest and patently disinterested. I wish you well and would like to help.

Wednesday, 2 March 2016

Today is a day of scudding clouds; of brilliant sunshine and pelting rain. The most constant feature seems to be the intermittant wind that 'whistles' round the exposed end of my house. But this is not the ordinary sound of 'whistling' wind, which sounds about as musical as the din you hear when standing on a motorway bridge. My house whistles more like an orchestra. Previous owners seem to have fitted struts that operate like mouthorgan reeds, and television cables that throb like harp-strings. But the triumph, which lifts this house above its peers, are the holes drilled through the brickwork to feed cables from security cameras, vent cisterns and the like. These, when the wind hits precisely the right angle, emit a sound that stops conversation, and brings a startled look to the faces of visitors; sometimes a wail, sometimes a hoot, sometimes high-pitched and sometimes low depending on the bore.

Even I, who have lived here for nigh-on a year, am amazed when one of these tubes catches a good blast of wind.

About Me

My Cawstein profile shows me struggling to understand politics, economics, and occasionally philosophy, commenting on the misuse of the English language and other perceived follies gaining currency in our times

Of course, this Cawstein only emerged when the web itself emerged. Before that there was neither the means of developing these characteristic ideas, nor the time. I suffered as a child the constraint of having to go to school. Then there were 45 years of disciplined application to a career in academic biochemistry (where my contributions lay in bioenergetics and membrane transport, chiefly in bacteria and mitochondria).